Stienen Martin Nikolaus, Maldaner Nicolai, Sosnova Marketa, Joswig Holger, Corniola Marco Vincenzo, Regli Luca, Hildebrandt Gerhard, Schaller Karl, Gautschi Oliver Pascal
Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
Neurospine. 2020 Mar;17(1):270-280. doi: 10.14245/ns.1938368.184. Epub 2020 Jan 26.
The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today's gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure.
We evaluated patients with lumbar DDD from a prospective 2-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 [normal] -0 [no movement]). The PROM-based evaluation included pain (visual analogue scale), disability (Oswestry Disability Index [ODI] & Roland-Morris Disability Index [RMDI]), and health-related quality of life (HRQoL; Short-Form 12 physical component summary/mental component summary & EuroQol-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value.
One hundred five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI: 52.8 vs. 48.2, p = 0.025; RMDI: 12.6 vs. 11.3, p = 0.034) but similar pain and HRQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p = 0.006). When comparing patients with high- (BMRC 0-2) vs. low-grade LEMD (BMRC 3-4), no difference was evident for the PROM-based evaluation (all p > 0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p = 0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs.
Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.
基于患者报告结局量表（PROM）对腰椎退行性椎间盘疾病（DDD）进行评估是目前的金标准，但存在局限性。我们研究了下肢运动功能障碍（LEMD）对PROM及一项新的客观结局指标的影响。
我们从一个前瞻性的双中心数据库中评估腰椎DDD患者。根据英国医学研究委员会（BMRC；5[正常]-0[无运动]）对LEMD进行分级。基于PROM的评估包括疼痛（视觉模拟量表）、残疾程度（Oswestry功能障碍指数[ODI]和罗兰-莫里斯功能障碍指数[RMDI]）以及健康相关生活质量（HRQoL；简明健康调查12项量表的身体成分总结/精神成分总结和欧洲五维度健康量表指数）。客观功能损害（OFI）通过年龄和性别校正的计时起立行走（TUG）测试值来确定。
375例患者中有105例（28.0%）存在LEMD。存在LEMD的患者残疾程度略高（ODI：52.8对48.2，p = 0.025；RMDI：12.6对11.3，p = 0.034），但疼痛和HRQoL评分相似。存在LEMD的患者OFI T评分显著更高（144.2对124.3，p = 0.006）。比较重度（BMRC 0 - 2）与轻度LEMD（BMRC 3 - 4）患者时，基于PROM的评估无明显差异（所有p>0.05），但重度LEMD患者的OFI T评分明显更高（280.9对136.0，p = 0.001）。存在LEMD的患者TUG测试时间和OFI T评分均高于无LEMD的匹配对照组。
我们的数据表明，PROM未能充分考虑与LEMD相关的残疾情况，这种情况很常见，且常常困扰患者。TUG测试的客观功能评估似乎对与LEMD相关的残疾更敏感。对存在LEMD的患者进行客观功能评估似乎是合理的。
